Donath et al.

BMC Public Health 2011, 11:84

http://www.biomedcentral.com/1471-2458/11/84

RESEARCH ARTICLE Open Access

Alcohol consumption and binge drinking in

adolescents: comparison of different migration
backgrounds and rural vs. urban residence-a
representative study
Carolin Donath1*, Elmar Gräßel1, Dirk Baier2, Christian Pfeiffer2, Deniz Karagülle3, Stefan Bleich3,
Thomas Hillemacher3

Abstract
Background: Binge drinking is a constant problem behavior in adolescents across Europe. Epidemiological
investigations have been reported. However, epidemiological data on alcohol consumption of adolescents with
different migration backgrounds are rare. Furthermore representative data on rural-urban comparison concerning
alcohol consumption and binge drinking are lacking. The aims of the study are the investigation of alcohol
consumption patterns with respect to a) urban-rural differences and b) differences according to migration
background.
Methods: In the years 2007/2008, a representative written survey of N = 44,610 students in the 9th. grade of
different school types in Germany was carried out (net sample). The return rate of questionnaires was 88%
regarding all students whose teachers respectively school directors had agreed to participate in the study.
Weighting factors were specified and used to make up for regional and school-type specific differences in return
rates. 27.4% of the adolescents surveyed have a migration background, whereby the Turkish culture is the largest
group followed by adolescents who emigrated from former Soviet Union states. The sample includes seven large
cities (over 500,000 inhabitants) (12.2%), independent smaller cities ("urban districts”) (19.0%) and rural areas ("rural
districts”) (68.8%).
Results: Life-time prevalence for alcohol consumption differs significantly between rural (93.7%) and urban areas
(86.6% large cities; 89.1% smaller cities) with a higher prevalence in rural areas. The same accounts for 12-month
prevalence for alcohol consumption. 57.3% of the rural, re-spectively 45.9% of the urban adolescents engaged in
binge drinking in the 4 weeks prior to the survey. Students with migration background of the former Soviet Union
showed mainly drinking behavior similar to that of German adolescents. Adolescents with Turkish roots had
engaged in binge drinking in the last four weeks less frequently than adolescents of German descent (23.6% vs.
57.4%). However, in those adolescents who consumed alcohol in the last 4 weeks, binge drinking is very
prominent across the cultural backgrounds.
Conclusions: Binge drinking is a common problem behavior in German adolescents. Obviously adolescents with
rural residence have fewer alternatives for engaging in interesting leisure activities than adolescents living in cities.
This might be one reason for the more problematic consumption patterns there. Common expectations
concerning drinking behavior of adolescents of certain cultural backgrounds (’migrants with Russian background
drink more’/’migrants from Arabic respectively Oriental-Islamic countries drink less’) are only partly affirmed.
Possibly, the degree of acculturation to the permissive German alcohol culture plays a role here.

* Correspondence: carolin.donath@uk-erlangen.de
1
Psychiatric University Clinic Erlangen, Department Medical Psychology and
Medical Sociology, Schwabachanlage 6, 91054 Erlangen, Germany
Full list of author information is available at the end of the article

© 2011 Donath et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Donath et al. BMC Public Health 2011, 11:84
http://www.biomedcentral.com/1471-2458/11/84
Background
Problematic alcohol consumption patterns including
binge drinking is a constant evi-dent behavior in many
adolescents across Europe and the USA [1-3]. Aside
from the direct con-sequences of intoxication and its
possible somatic complications, the long-term conse-
quences of this consumption pattern are disadvantages
in different social areas of life (school, education, job
perspectives; risky behavior in traffic and sexual activity
[4,5]; delinquency [6]) and according to the latest
research also biological changes in neuronal processes of
the hippocampus likely resulting in memory and cogni-
tive deficits [7]. Often the drinking behavior is asso-
ciated with certain cultural or seasonal events, like
“Spring Break” in the U.S.A., certain folk festivals like
the Oktoberfest in Germany, “Botellóns” in Spain, or
internet-organized (using social networks) spontaneous
drinking parties on public places in France. However, it
seems, according to epidemiological data, that excessive
alcohol consumption is not limited to one or two events
per year but is a regular leisure time activity for many
adolescents and university students [8]. The 2007
ESPAD report (European survey of 15-/16 year-olds
concerning substance use in 35 European countries)
states that heavy episodic drinking (having had 5 or
more drinks on one occasion in the last 30 days) varies
across Europe between 20% (Iceland) and 60% (Den-
mark). No data are reported for Germany. Except for
the north-western part of Europe, boys more often con-
sume heavily on any one occasion than girls [9,10]. The
German Federal Center for Health Education regularly
carries out a representative survey of 12- to 17-year olds
concerning their substance consumption. The 2008 data
concerning alcohol consumption show that alcohol was
the most-widely used psychoactive substance: three-
fourths of the adolescents stated its use. 17.4% of the
adolescents consume alcohol weekly or more often,
again boys in a greater proportion than girls [11]. Binge
drinking (same definition as in the ESPAD-study) is
reported by 20.4% of the 12-to-17-year-olds. The
“Child-and-Youth-Health-Survey” carried out by the
Robert Koch Institute on behalf of the German Ministry
of Health [12] also reflects for the first time in a repre-
sentative sample selective aspects of the consumption
patterns of adolescents with migration background.
Concerning alcohol, the consumption frequency is
reported as regular use. While 40.8% of the 11-17-year-
olds without migration background regularly consume
alcohol (at least once a week), adolescents with one-
sided or two-sided migration background do this more
rarely (34.0% respectively. 17.9%). Because of the lack of
more detailed data concerning alcohol consumption pat-
terns in adolescents with migration background in
Page 2 of 14
Germany in the representative studies cited, a closer
look at it will be taken in this work. Therefore, the first
question which will be investigated in this work is: How
can consumption patterns including binge drinking be
described in adolescents with migration background in
comparison to German adolescents? Furthermore, none
of the above-mentioned representative data collections
reports on possible consumption differences between
rural and urban residence of the adolescents. However,
it is known that environmental influences can play a
role in the development of problem drinking behavior
[13]. Therefore, as a second question, consumption pat-
terns are investigated in this work from the perspective
of possible rural-urban differences.
Aims
I) Description of consumption patterns with respect
to possible differences between urban and rural
residence
II) Description of consumption patterns in adoles-
cents with different migration backgrounds living in
Germany
Methods
Design
The matter concerns a representative survey of 9th-gra-
ders in Germany which was carried out in 2007/2008.
In the year 2006, there were 910,000 9th-graders in Ger-
many. The goal was to survey 50,000 adolescents from
different regions. The basis for the selection of the
regions was the federal classification of rural districts
and independent cities (urban districts) which total up
to 440. The latter contain cities of each size (below
100,000 up to 3.3 million (Berlin) inhabitants). The
number of inhabitants in the rural districts also varies
from about 50,000 to over 600,000. Therefore, the rural
and urban districts (= regions) were sorted into classes
of region size in which the random drawing then took
place. The classes of region size were: Western Germany
(urban districts): cities with more than 500,000 inhabi-
tants, cities with more than 100,000 inhabitants, cities
with less than 100,000 inhabitants; Western Germany
(rural districts): districts with more than 100,000 inhabi-
tants, districts with less than 100,000 inhabitants; East-
ern Germany (former GDR) (urban districts): cities with
more than 100,000 inhabitants (there are only two cities
with more than 500,000 inhabitants), cities with less
than 100,000 inhabitants; Eastern Germany (former
GDR) (rural districts): districts with more than 100,000
inhabitants, districts with less than 100,000 inhabitants;
special case: Berlin. With the knowledge about the num-
ber of 9 th -graders in each class of region size (from
the official education statistics) and the goal of 50,000
Donath et al. BMC Public Health 2011, 11:84
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adolescents to be questioned, it was possible to calculate
how many adolescents per class of region size had to be
included. It has to be taken in account that not students
but classes were drawn by chance. The number of
50,000 students refers to a goal of 2,500 classes. It is
known that about 20 students per class can be retrieved
and used for data analysis. The number of 2,500 classes
was chosen in the way that for every region in Germany
which was supposed to be represented in the survey a
sufficient number of classes was evident. The goal was
to display the distribution of the 9 th -graders in the
classes of region size (in the population) to the same
percentage in the sample. It was assumed that every 2nd
student (in large cities every 6 th student) in a drawn
region would be questioned. Thus it could be calculated
how many re-gions had to be drawn out of every class
of region size. These steps resulted in 61 regions. Which
region was chosen to take part was then drawn by
chance in order to secure a representative sample. At
the Criminological Research Institute of Lower Saxony,
the sample was drawn stratified to school type (on basis
of school lists provided by the local education authori-
ties). A master list on which all school classes (9thgrade)
of one region were consecutively sorted was used. Then
all directors of the drawn schools were informed in writ-
ing about the survey and asked for participation of their
9th-grade school classes. If the directors agreed to the
survey, information material including consent forms for
parents were sent to the schools. On a concerted
appointed day, the written survey was carried out with-
out the students whose parents refused participation,
who themselves refused to participate or who were
otherwise busy respectively absent during the survey.
The survey at the school was carried out by trained
external study assistants - not by the employees of the
schools - in order to preserve reliability and validity. A
detailed description of the design and implementation of
the study is published elsewhere [14].
The research project was granted by the Federal Min-
istry of the Interior in Germany, a statement of an
ethics committee was not necessary. Instead the survey
was audited by each Ministry of Education of every
German state (Bundesland) and additionally of every
state responsible for data protection. Only in those
states where through this procedure the survey was per-
mitted the survey then actually took place. A further
ethics committee was not included since the data pro-
tection matters were covered by the above described
procedure and another intervention besides filling out
an anonymous questionnaire was not applied.
Instruments
Substance consumption was investigated substance- (and
beverage-) specific with items used in a representative
Page 3 of 14
survey of the Criminological Research Institute of Lower
Saxony in 2001 [15]. In this work, only data concerning
alcohol, including the beverages beer, wine/sparkling
wine, alcopops and hard liquor, are presented. The ado-
lescents were asked if they had a) tried the specific sub-
stance already once in their lifetime, b) how old they
were when they did that and c) how often they had con-
sumed the specific substance during the last twelve
months. The answer categories were: a) yes/no, b) 6, 7, 8,
(...), 20 years or older and c) never, 1 to 12 times a year,
several times a month, once or more per week, daily. The
item assessing heavy episodic drinking (binge drinking)
was derived from the representative survey of adolescents
of the German Federal Center for Health Education [16].
Binge drinking is defined as the consumption of five or
more standard drinks at one drinking opportunity. The
adolescents were asked a) if they had consumed alcohol
in the last 30 days (30-day-prevalence) and if yes, b) on
how many days they had consumed 5 or more standard
alcoholic drinks in a row. The answer categories were a)
yes/no and b) not on one day, on one day, on two days,
(...), on 20 or more days.
The urban-rural comparison is based on the following
definition: large cities (> 500,000 inhabitants), indepen-
dent urban districts (smaller cities with more than
100,000 or less than 100,000 inhabitants) and rural dis-
tricts. Data concerning residence were obtained through
the sampling method and did not need to be included
in the questionnaire. Migration background was defined
as having at least one parent who was born outside of
Germany or having been born outside of Germany one-
self or having non-German citizenship or having at least
one parent of non-German citizenship. The birth place
and citizenship of the adolescent and its parents were
included in the questionnaire. In the case of discrepan-
cies between the citizenship of mother and father, the
status of the mother was used.
Sample
A total of 3052 classes (9th grade) with 71,891 students
were drawn. For 921 classes (21,181 students) the direc-
tors/main class teachers refused to participate. 2,131
classes participated with a total of 44,610 students.
Actually the 2,131 classes included 50,708 students, but
6,098 of them did not participate (reasons for example:
parents refusal or absenteeism). Figure 1 comprises a
detailed flow-chart on the sample record.
The return rates (students, without director refusal)
differed between the school types in that grammar/sec-
ondary schools as well as private/not state-run schools
had the highest return rates (92.0/92.8) and special
schools the lowest (75.5). Furthermore, the return rates
differed between the classes of region size. In the large
cities, the return rate was lower in comparison with
Donath et al. BMC Public Health 2011, 11:84
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Drawn classes: 3052 Drawn students: 71891
Director/class
teacher
refused: 921
classes
Students in participating
Participating classes: classes: 50708
2131
Return rate -
classes: 69.8 % Participating students:
44610
Return rate - students:
88.0 % (without director
refusal)
62.1 % (all drawn
students)
Class level Student level
Figure 1 Sample constitution.
rural districts and urban districts with less than 500,000
inhabitants. In spite of the varying return rates in the
different classes of region size, the realized sample
represents the proportions of the population very well
(for example students living in cities with more than
100,000 inhabitants in Western Germany: 12.04% in
the sample and 11.68% in the population). The propor-
tion of students in the 9 th grade in every class of
region size in West and Eastern Germany was com-
pared to their proportion in the sample. With those
two percentages for each category the reliability can be
seen and rated. The proportions never differed more
than .36% between population and sample in the dif-
ferent classes of region size except for Berlin where
the difference was .62%.
In consequence of the varying return rates, weighting
factors were calculated so that the proportion of school
forms in the sample corresponds to that in the popula-
tion and in the same manner, the proportion of regions
with different sizes in the sample corresponds to that in
the population. The two weighting factors were multipli-
catively connected when data of the total sample were
analyzed. Thereby the imbalances regarding the school
forms were eliminated, as were the much smaller imbal-
ances regarding the classes of region size.
Page 4 of 14
Director/class
teacher refused:
21181 students
Not
participated:
6098 students
Reasons:
Æ 711 parents refused
Æ 474 student refused
Æ 4713 absent (sickness, student
exchange, truancy, other)
Æ 200 obviously not seriously filled out
The sample can be characterized as follows: 51.3% of
the sample are male students, the mean age is 15.3 (SD
0.7) years. The percentage of adolescents with migration
background is 27.4, whereby students with a Turkish
migration background constitute the largest group
(6.0%; more than 2,600 students) followed by emigrants
from the former Soviet Union states (5.8%; more than
2,500 students). A total of 12.2% lives in large cities
with more than 500,000 inhabitants including Berlin
while the majority lives in rural districts (68.8%). The
migration background varies between 39.9% in large
cities with more than 500,000 inhabitants and 23.9% in
rural districts.
Statistical analysis
Prevalence analyses were carried out with descriptive
statistics. Group differences were analyzed according to
the measurement level of the variable with ANOVAs
(continuous variables) respectively Chi2-tests (categorical
variables). SPSS 17.0 was used. Questions concerning
substance consumption beyond life-time use were only
analyzed for adolescents with positive life-time preva-
lence (who answered “yes” to the question if they had
ever tried alcohol). Other staged questions were handled
in the same manner. Because of the sample size, the
Donath et al. BMC Public Health 2011, 11:84
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level of significance was set to p = .001 [17]; exceptions
are mentioned. A sensitivity analysis was carried out to
disentangle the rural-urban differences from the differ-
ent proportions of adolescents with migration back-
ground living there. Rural-urban differences concerning
life-time-prevalence and 12-month-prevalence for alco-
hol in general and the different alcoholic beverages were
additionally explored with German adolescents only
(without migration background). Again, Chi2-tests were
used to explore statistically significant differences in the
prevalence. The aim of the sensitivity analysis was to
confirm statistical differences between urban and rural
consumption patterns detected in the whole sample by
only looking at the German adolescents so that the dif-
ference cannot be attributed to adolescents with migra-
tion background.
Results
Alcohol consumption patterns in a rural-urban
comparison
Life-time prevalence for alcohol differs significantly (p <
.001) between rural districts (93.7%) and urban areas
(86.6% for large cities/89.1% smaller cities). It varies
according to the beverage: the highest life-time preva-
lence exists for beer (86.1%), the lowest for hard liquor
(55.2%) independent of place of residence. However for
every alcoholic beverage which was investigated, the life-
time prevalence is higher in rural areas (p < .001) (see
Figure 2). The age of first alcohol consumption differs
descriptively by about 0.2 respectively 0.1 month
between urban and rural residence for the beverages
beer (F (2) = 14.91; p < .001) and alcopops (F (2) =
14.03; p < .001). Adolescents living in rural areas con-
sume these beverages earlier for the first time in their
life than adolescents who live in smaller or large cities.
There is no significant difference in the age of first con-
sumption of alcohol in general (p = .137), for wine/
sparkling wine (p = .206) and for hard liquor (p = .076)
which can be seen in Figure 3 that includes the mean
values and standard deviations of age of first consump-
tion (Figure 3). The 12-month prevalence for alcohol in
general and for each beverage differ significantly (p <
.001) between urban and rural adolescents. For example,
the percentage of never-consumers is highest in large
cities and lowest in rural districts (see Table 1). Further-
more, the percentage of 9th-grade stu-dents who regu-
larly consume alcohol (once a week or more often) is
considerably higher in rural areas: about one-fourth
(24.4%) versus 19.1% in large cities and 20.0% in smaller
cities (= urban districts). This is not only true for alco-
hol in general but can be observed for every beverage.
A sensitivity analysis was carried out to disentangle
the rural-urban differences from the different propor-
tions of adolescents with migration background living
Page 5 of 14
there. Rural-urban dif-ferences concerning life-time-pre-
valence and 12-month-prevalence for alcohol in general
and the different alcoholic beverages were additionally
explored with German adolescents only (without migra-
tion background). The urban-rural differences were
obvious in the same direction and mostly statistically
significant: The life-time prevalence for all alcoholic
beverages is higher in adolescents with rural residence
in comparison to urban residence: beer 90.8% vs. 86.7%
(p < .001); wine/sparkling wine 82.0% vs. 84.4% (p =
.002); alcopops 64.6% vs. 67.1% (p = .003); hard liquor
50.6% vs. 63.6% (p < .001). The 12-months prevalence is
also higher for every alcohol beverage in adolescents
with rural living background (p ≤ .001).
The proportion of adolescents who engaged in binge
drinking (≥5 drinks on one occasion) in the preceding
30 days is 45.2% for large cities, 46.7% for smaller cities
and 57.3% for rural areas, which results in a statistically
significant difference (p < .001). Regarding only those
adolescents who stated to have consumed alcohol in the
last 30 days, the percentage of binge drinking is higher:
74.5% for large cities, 72.9% for smaller cities and 78.4%
for rural areas. That means if adolescents do drink alco-
hol, they tend to drink many drinks on one occasion
rather than consuming in a moderate manner. Those
adolescents that engage in binge drinking are doing that
on 4 to 5 of 30 days on average. Adolescents living in
rural areas show that behavior slightly more often (4.68
days vs. 4.45 days in large cities) (F (2) = 25.04; p <
.001).
Alcohol consumption patterns in adolescents with
migration background
Life-time prevalence for alcohol varies according to the
cultural background of the adolescents who migrated to
Germany and differs in part substantially from that of
German 15-year-olds (Figure 4). As expected, adoles-
cents from Islamic countries have lower life-time preva-
lence than German or Western European adolescents,
except for students from Iran. The three largest groups
of 15-year-old students in Germany are compared for
the life-time prevalence of specific alcoholic beverages:
Germans, adolescents with Turkish migration back-
ground and students who emigrated from the former
Soviet Union states. As shown in Figure 5 beverage spe-
cific life-time prevalence shows the same pattern as life-
time prevalence of alcohol with differences between
Turkish adolescents and more similar behavior among
German and former Soviet Union adolescents. In all
three cultural groups, beer is the most commonly tried
beverage followed by wine/sparkling wine and alcopops.
Hard liquor is the least often tried alcoholic beverage.
However, German adolescents have the highest bever-
age-specific life-time prevalence of the three groups and
Donath et al. BMC Public Health 2011, 11:84 Page 6 of 14
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Figure 2 Life-time prevalence of consumption of alcoholic beverages and alcohol in general: urban-rural comparison.

for hard liquor even of all nations included in the study background 12.21 (SD 2.54). This difference is statisti-
(Figure 6). The age of first consumption of alcohol in cally significant (F (2) = 147.85; p < .001). Beverage spe-
general among German adolescents is 12.50 years (SD cific analyses show that basically the youth tries first
1.98), in adolescents with Turkish background 13.34 beer, later wine and sparkling wine, then alcopops and
(SD 2.01) and adolescents with Russian associated last hard liquor. For German adolescents, there is the
exception that the age at first consumption of wine and
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of beer is nearly the same (12.91 years (SD 1.83) and

12.93 years (SD 1.85)). German adolescents try after
 beer and wine alcopops at an average age of 13.85 (SD

    
      1.26) years and hard liquor at an average age of 14.02
   
 years. Students with “Russian” migration background try
 beer with 12.52 (SD 2.47) years, wine respectively spark-
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ling wine with 12.96 (SD 2.17) years, alcopops at an
average age of 13.95 (SD 1.57) and hard liquor as the

latest beverage at an average age of 14.12 (SD 1.71)

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of 13.45 (SD 2.04), later wine or sparkling wine at an
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Figure 3 Age of first alcohol consumption: urban-rural
migration backgrounds as ANOVAs have shown (p <
comparison.
.001 for beer, wine, alcopops). However, the first
Donath et al. BMC Public Health 2011, 11:84 Page 7 of 14
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Table 1 12-month prevalence of consumption of alcoholic beverages and alcohol in general: urban-rural comparison
Beverage 12-month-prevalence N Large Urban Rural p
city district district (Chi2)
(%) (%) (%)
Beer Never 8668 27.7 25.2 17.3 < .001
1-12 times/year 16458 37.5 38.8 38.0
Several times/month 9135 18.1 18.4 22.4
1 or several times/week 8527 15.7 16.8 21.2
daily 456 1.0 0.8 1.1
Wine/ Never 12058 33.7 30.4 26.2 < .001
Sparkling Wine
1-12 times/year 20834 54.8 56.6 59.9
Several times/month 4102 7.9 8.7 10.0
1 or several times/week 1600 3.5 4.1 3.6
daily 82 0.2 0.2 0.2
Alcopops Never 17406 43.0 43.7 39.0 < .001
1-12 times/year 15699 35.6 35.6 36.8
Several times/month 6442 13.2 12.7 15.8
1 or several times/week 3441 7.8 7.5 8.0
daily 158 0.5 0.4 0.3
Hard Never 20999 60.8 54.3 44.9 < .001
liquor
1-12 times/year 14868 27.9 32.1 36.3
Several times/month 4653 7.0 8.5 12.1
1 or several times/week 2537 4.1 4.8 6.5
daily 103 0.2 0.2 0.3
Alcohol in general Never 5557 18.6 16.5 10.7 < .001
1-12 times/year 17755 42.0 43.0 39.8
Several times/month 10301 20.3 20.6 25.0
1 or several times/week 9488 17.8 19.0 23.1
daily 540 1.3 1.0 1.3

consumption age of hard liquor is not significantly dif-
ferent between adolescents from different cultural back-
grounds (F (2) = 3.54; p = .029). Comparison of the
three cultural groups concerning the 12-month preva-
lence of alcohol consumption shows that almost one-
fourth (24.7%) of the German 15-year-olds, less than
10% of the adolescents with Turkish roots (8.4%) and
about one-fourth (24.4%) of the adolescents from the
former Soviet Union drink alcohol regularly - at least
once a week (Figure 7). Beverage-specific 12-month pre-
valence for the three most common cultural groups in
the sample are shown in Table 2. There are significant
differences between the three groups for each beverage
(p < .001); adolescents with “Russian background” have
the highest prevalence of regular consumption (at least
once a week) of hard liquor (7.7%), alcopops (9.1%) and
wine/sparkling wine (4.9%) followed closely by the Ger-
man adolescents with very analogical drinking behavior
who have the highest prevalence for regular beer
consumption (at least once a week) of the three groups
(22.5%). The proportion of adolescents who engaged in
binge drinking (≥5 drinks on one occasion) in the last
30 days is 57.4% for German 15-year-olds, 23.6% for
adolescents with Turkish roots and 56.2% for former
Soviet Union emigrants. Looking at the broad range of
nations included in the sample, it is evident that binge
drinking is most common in adolescents with Western
European or North-American background. As to be
expected in adolescents who have cultural roots in Isla-
mic-imprinted countries, binge drinking is less evident
in general. A different picture opens, though, if one
looks only at the adolescents who stated to have con-
sumed alcohol in the last 30 days. Here the adolescents
with the two highest binge drinking prevalence are des-
cendents of Oriental-Islamic parents, meaning that if
adolescents from these countries do consume alcohol,
they almost always do it excessively. But also the des-
cendents of Western, Eastern and South-European
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answering this question

Figure 4 Life-time prevalence alcohol consumption for all cultural groups of the sample.

parents have a high prevalence of binge drinking when focus of the analyses was the comparison of adolescents
only consumers in the past 30 days are considered (for living in rural and urban settings, and furthermore the
example former Yugoslavia, Netherlands, Spain) (see comparison of adolescents with different migration
Figure 8). The frequency on how many days binge drin- backgrounds in contrast to “native” German 9th-graders.
kers engage in this risky behavior varies significantly Obviously there are differences in alcohol consump-
between binge drinkers from different cultural back- tion between the areas of residence. Adolescents from
grounds (F (21) = 2,526; p < .001). The range is between rural areas were more rarely “never-drinkers” with
2.83 and 6.57 days in the past 30 days. Looking at the respect to having tried alcohol at least once in their life-
three biggest groups in the sample, it is obvious that time and also relating to their drinking behavior in the
German students and adolescents from the former last 12 months. Even though this might be partly
Soviet Union act similarly, engaging in binge drinking explainable by the higher proportion of adolescents with
on 4.58 (SD 4.13) or respectively 4.54 (SD 4.35) days in migration background living in cities, migration back-
the last month. The 15-year-olds with Turkish roots ground does not seem to be a sufficient factor to explain
who admit to engage in binge drinking had done so on the difference. Sensitivity analyses showed that the life-
5.09 (SD 5.51) days during the last month. The three time-prevalence and 12-month prevalence also differ
groups do not differ statistically significantly in this significantly between rural and urban areas if only
variable. “German” adolescents are taken into account. Further-
more, the differences were also shown in a multivariate
Discussion analysis of the sample for drugs in general. This consti-
This study uses representative data to generate insight tuted a regression analysis with consumption as depen-
into the variety of substance consumption patterns of dent variable. The control variable urban/rural turned
15-year-old adolescents living in Germany. The main out to be significant [18].
Donath et al. BMC Public Health 2011, 11:84 Page 9 of 14
http://www.biomedcentral.com/1471-2458/11/84

Beverage-specific life-time prevalence

100
89,9 90
90 84
79,6
80
70 66,6
61 62,5
60 53,3 50,5
%

50
38 36,6
40
30
20 15,5
10
0
German Former Soviet Union Turkish
Q  Q  Q 
Beer Wine/Sparkling Wine Alcopops Hard liquor
Figure 5 Beverage-specific life-time prevalence for adolescents with German, Turkish and former Soviet Union cultural background.

Migration background seems to be reflected in the they engage quite often in excessive consumption pat-
proportion of never-drinkers during the life-time and terns just like their German counterparts. This is also
during the last 12 months, especially in adolescents with true for the adolescents with roots in Islamic-imprinted
Arabic respectively Oriental-Islamic roots. However, if countries who admit to have consumed alcohol lately.
adolescents with migration background do drink at all, In summary, 15-year-olds residing in rural areas drink
on more occasions a year, engage more often in binge
drinking and have higher life-time prevalence for all
/LIHWLPHSUHYDOHQFHKDUGOLTXRU
alcoholic beverages than 15-year-olds residing in urban

areas. The age of first consumption of alcohol does not
 
  

vary significantly though. One hypothesis for the urban-
 
 

  
rural difference could be that in rural areas less multifa-



ceted leisure time activities are available, so that a



 certain part of the adolescents engages more often in



regular alcohol consumption. A study with hints of dif-
  ferent consumption types (“TV-type”, “party-type”, “cul-
 

ture-type”, “sport-type”) would support this, describing





that the “TV-type” drinks more often because of bore-
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dom and because of problems [19]. Furthermore in

rural areas, cultural traditions are still more strongly
anchored and cultural events are celebrated by a broad
Figure 6 Life-time prevalence for consumption of hard liquor community of inhabitants. In Germany such cultural
in 15-year-olds - comparison according to migration
events (like country fairs) are traditionally strongly con-
background.
nected with alcohol consumption. Alcohol consumption
Donath et al. BMC Public Health 2011, 11:84
http://www.biomedcentral.com/1471-2458/11/84
PRQWKSUHYDOHQFHDOFRKRO


 

 







 Q 
*HUPDQ )RUPHU6RYLHW
8QLRQ
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Figure 7 12-month-prevalence of alcohol consumption for adolescents with German, Turkish and former Soviet Union cultural
background.
is positively connotated, Germany has a permissive-
drinking culture. Since environmental and societal fac-
tors play an important role in influencing the drinking
behavior of adolescents [20] and young adults [21], the
existing consumption patterns are actually no surprise.
Especially since it is known that parental drinking beha-
vior [22] and parental attitudes [23,24] toward alcohol
consumption influence the alcohol consumption pat-
terns of the adolescents.
Concerning the consumption patterns of adolescents
with migration background, it has to be stated that, as
expected, adolescents from countries with Arabic
respectively Muslim culture drink to a significantly
smaller proportion than German or other Western ado-
lescents. Results in this direction were also reported in
the KIGGS-survey [12]. Contrary to expectations, ado-
lescents from the former Soviet Union, which is also
known for its permissive drinking culture especially con-
cerning hard liquor, do not differ substantially from
German adolescents in their drinking behavior. To the
Page 10 of 14






 
Q  Q 
7XUNLVK
WLPHVSHU\HDU
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contrary: Germans have the highest life-time prevalence
for hard liquor compared to all other cultural back-
grounds. However, adolescents from the former Soviet
Union have the highest regular consumption (at least
once a week) of hard liquor, alcopops and wine com-
pared to German adolescents and adolescents with
Turkish roots. But the Germans have the highest preva-
lence of regular beer consumption. Obviously culture-
specific preferences for certain alcoholic beverages stay
stabile and do not change in the adopted country.
Another hint for that can be seen in the highest life-
time prevalence for wine in French and Italian 15-year-
olds compared to all other nations which was observed
in an additional sensitivity analysis.
Looking at excessive drinking behavior, the prevalence
varies enormously when all adolescents from all nations
are included. Still, more than every second 15-year-old
student from basically all West- and East-European
countries respectively from the USA engaged in binge
drinking in the last 30-day period. A different extent of
Donath et al. BMC Public Health 2011, 11:84 Page 11 of 14
http://www.biomedcentral.com/1471-2458/11/84

Table 2 Beverage-specific 12-month-prevalence for adolescents with German, Turkish and former Soviet Union cultural
background
Beverage 12-month-prevalence N German Turkish Former p
roots roots Soviet (Chi2)
(%) (%) Union
roots
(%)
Beer Never 6741 15.6 58.0 18.5 < .001
1-12 times/year 13269 38.6 29.3 39.9

Several times/month 7871 23.3 6.2 20.5

1 or several times/week 7316 21.5 5.8 19.8

daily 365 1.0 0.6 1.2

Wine/Sparkling Wine Never 9558 23.0 69.6 28.8 < .001

1-12 times/year 21422 62.5 26.7 57.5

Several times/month 3519 10.5 2.2 9.1

1 or several times/week 1340 3.8 1.3 4.7

daily 64 0.2 0.1 0.2

Alcopops Never 14288 37.3 67.7 42.9 < .001

1-12 times/year 13208 38.2 22.3 34.0

Several times/month 5439 16.0 5.3 14.0

1 or several times/week 2830 8.2 4.1 8.7

daily 124 0.3 0.5 0.4

Hard liquor Never 16746 43.0 86.9 51.8 < .001

1-12 times/year 12845 38.4 9.4 29.9

Several times/month 4078 12.2 1.9 10.6

1 or several times/week 2144 6.2 1.8 7.5

daily 77 0.2 0.2 0.2

Alcohol in general Never 4192 8.5 48.8 11.8 < .001

1-12 times/year 14726 41.0 35.2 40.6
Several times/month 8836 25.8 7.7 23.2
1 or several times/week 8083 23.5 7.3 23.0
daily 435 1.2 1.1 1.4

binge drinking is only seen in adolescents who emi-
grated from continents other than Europe or North
America. The picture changes when looking only at
those who admitted to having consumed alcohol in the
last 30-days. Of those adolescents, only a marginally
small proportion drinks alcohol in a controlled, not
excessive manner. Regardless of cultural background, at
least two-thirds of those adolescents engaged in binge-
drinking at least once, while more than 3/4 of the
German adolescents did so. It is striking that excessive
drinking behavior is more dominant than the rather cul-
turally-accepted restricted drinking behavior in adoles-
cents who do drink alcohol. Norman et al. [25] give
some explanations for this. Obviously, regular drinking
seems to be associated with binge drinking but this
alone is not a sufficient explanation. Attitudinal determi-
nants and situational triggers seem to be of importance,
too. Situational triggers which lower the inhibition of
binge drinking behavior are for example events such as
celebrations or being at a party. Binge drinkers report
feeling under social pressure (“drinking pressure”) from
friends in those situations, whereby male binge drinkers
seem to have this impression more often than females.
Tucker et al. [24] showed that living in a permissive
household concerning alcohol and drug consumption
has an impact on extensive drinking behavior. Three-
fourths of the 9th-graders in this study who lived with
permissive parents engaged in heavy drinking [24].
Donath et al. BMC Public Health 2011, 11:84 Page 12 of 14
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%LQJH'ULQNLQJ

















































































n = 17833


n = 1377


n = 711
n = 104

n = 101

n = 163

n = 337

n = 315
n = 108

n = 600
n = 97

n = 59

n = 82

n = 92

n = 66

n = 52

n = 21

n = 22

n = 16
n = 39


n = 19

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N = number of students
engaging in BD

EDVHDOOVWXGHQWV EDVHVWXGHQWVZLWKDOFRKROFRQVXPSWLRQLQWKHODVWGD\V
Figure 8 Binge drinking in 15-year-olds - comparison according to migration back-ground.

But not only permissive attitudes of parents but also colleagues in alcohol consumption, maybe even more,
positive attitudes towards binge drinking of the adoles- since they were unwilling to disclose this behavior. It
cents themselves and their expectation of positive conse- could therefore be possible that the number of consu-
quences is obviously associated with the behavior [25]. mers respectively binge drinkers is even underestimated.
The analyses of the study are based on a large repre- This should lead to an even stronger focusing on the
sentative sample of adolescents which suggests validity need for prevention measures and legal regulations
of the data. The response rate is lower than in the com- which function in the sense of structural prevention.
parable German part of the ESPAD-study, a representa- When interpreting the consumption patterns of the dif-
tive study with 12,448 participating students at the age ferent migration groups, one has to consider that some
of 15/16 years. The reasons are clearly identifiable: In groups are relatively small (less than 100 students) and
the ESPAD-study school classes were drawn to partici- get even smaller if only a small percentage of those
pate in a second round as substitute for all the classes engage for example in binge drinking. Results of these
which were as a whole not willing to participate (tea- small groups should not be over-interpreted. Further-
cher/head of the school decision). This has not taken more, it has to be taken into account that this was a
place in the here reported study. Therefore looking only cross-sectional study. It does not allow predicting sub-
at the response rates of those students, whose teachers/ stance consumption over time. This would be a very
head of schools decided to participate one can perceive interesting and new aspect to know, especially since
that the response rates are relatively similar to the data on substance consumption in different migration
ESPAD study (88.0% our study; 90.4% ESPAD study). groups in adulthood are rare.
However, it has to be taken into account that the ado- A definite need for research lies in the possible start-
lescents who refused to participate probably engage at ing points and kinds of effective prevention measures of
least to the same percentage as their participating problematic alcohol consumption behaviors including
Donath et al. BMC Public Health 2011, 11:84
http://www.biomedcentral.com/1471-2458/11/84
primary and secondary prevention. From the research
on tobacco prevention it is known that structural pre-
vention measures play an important role in primary and
also secondary prevention of smoking behavior [26-28].
To prove the efficacy of those structural measures for
adolescents living in a permissive drinking culture in
Germany would be an important research task.
In conclusion, the study showed that binge drinking is
a prevalent but not the only problematical drinking
behavior in 9th-graders in Germany. The majority of stu-
dents was under 16 and actually officially not allowed to
buy (and therefore consume) alcohol. However the life-
time prevalence of close to 100% at this age (except for
Muslim adolescents) shows that alcohol consumption
under the legal age is not at all uncommon. Problemati-
cal is also the percentage of adolescents who regularly
consume alcohol. About one-fourth are likely to
develop, respectively continue, risky alcohol consump-
tion in their adult life with possible alcohol-related pro-
blems (social, medical, etc.) [29]. The health
consequences that are risked range from brain damage
[30], damage to the gastrointestinal tract and cardiovas-
cular system up to long-term effects on blood-pressure,
in development of cancer and muscular-skeletal disor-
ders [31]. Thus, prevention measures should cover sev-
eral risky consumption patterns - binge drinking and
regular consumption - in order to prevent alcohol
related disorders in adult life.
Conclusions
A representative analysis showed that problematic alco-
hol consumption patterns (binge drinking, regular
weekly or daily consumption) are more common in ado-
lescents living in rural than in urban settings. Prevention
measures should therefore not only incorporate indivi-
dual approaches (behavior-oriented prevention) but also
environmental aspects (structural prevention). In the
best case, parents should also be targeted concerning
their attitudes towards their children’s alcohol consump-
tion. This leads to complex prevention approaches
which are the ones recommended by experts but which
are also expensive and difficult to implement in practice.
The complex prevention measures should include focus-
ing on culture-specific attitudes towards alcohol con-
sumption, towards specific beverages and critically
reflect the grade of societal permission of alcohol
consumption.
Acknowledgements
We thank ERAB (European Foundation for Alcohol Research;
former European Research Advisory Board) for supporting this study
(Grant EA 08 06).
Page 13 of 14
Author details
1
Psychiatric University Clinic Erlangen, Department Medical Psychology and
Medical Sociology, Schwabachanlage 6, 91054 Erlangen, Germany.
2
Criminological Research Institute of Lower Saxony, Lützerodestr. 9, 30161
Hannover, Germany. 3Center for Addiction Research, Clinic for Psychiatry,
Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-
Neuberg-Str. 1, 30625 Hannover, Germany.
Authors’ contributions
CD carried out data analysis and drafted the manuscript. DB worked out the
“Methods” section. CP planned and organized the data collection and
revised the manuscript. DK contributed to the background of the
manuscript and carried out a literature search. EG contributed to the
discussion and the structure of the results section. TH and SB organized the
study and helped with the data transfer. TH revised the manuscript. All
authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 4 August 2010 Accepted: 7 February 2011
Published: 7 February 2011
References
1. Karagülle D, Donath C, Grassel E, Bleich S, Hillemacher T: Binge Drinking in
Adolescents and Young Adults. Fortschritte der Neurologie - Psychiatrie
2010, 78(4):196-202.
2. Kraus L, Baumeister SE, Pabst A, Orth B: Association of Average Daily
Alcohol Consumption, Binge Drinking and Alcohol-Related Social
Problems: Results from the German Epidemiological Surveys of
Substance Abuse. Alcohol & Alcoholism 2009, 44(3):314-320.
3. Stolle M, Sack P-M, Thomasius R: Binge drinking in childhood and
adolescence. Deutsches Ärzteblatt International 2009, 106(19):323-328.
4. Champion HL, Foley KL, DuRant RH, Hensberry R, Altman D, Wolfson M:
Adolescent sexual victimization, use of alcohol and other substances,
and other health risk behaviors. Journal of Adolescent Health 2004,
35(4):321-328.
5. Hicks B, Morris J, Bass S, Holcomb G, Neblett W: Alcohol and the
adolescent trauma population. Journal of Pediatric Surgery 1990,
25(9):948-949.
6. Eklund JM, af Klinteberg B: Alcohol use and patterns of delinquent
behaviour in male and female adolescents. Alcohol & Alcoholism 2009,
44(6):607-614.
7. Taffe M, Kotzebue R, Crean R, Crawford E, Edwards S, Mandyam C: Long-
lasting reduction in hippocampal neurogenesis by alcohol consumption
in adolescent nonhuman primates. Proceedings of the National Academy of
Sciences 2010 [http://www.pnas.org/cgi/doi/10.1073/pnas.0912810107], Early
Edition.
8. Keller S, Maddock JE, Hannöver W, Thyrian JR, Basler H-D: Multiple health
risk behaviors in German first year university students. Preventive
Medicine 2008, 46:189-195.
9. Hibell B, Guttormsson U, Ahlström S, Balakireva O, Bjarnason T, Kokkevi A,
Kraus L: The 2007 ESPAD Report, Substance use among students in 35
European countrys. Stockholm: The Swedish Council for Information on
Alcohol and other Drugs (CAN), The European Monitoring Centre for Drugs
and Drug Addiction (EMCDDA), Council of Europe, Cooperation Group to
Combat Drug Abuse and Illicit Trafficking in Drugs (Pompidou Group); 2009.
10. Kraus L, Pabst A, Steiner S: Europäische Schülerstudie zu Alkohol und
anderen Drogen 2007 (ESPAD): Befragung von Schülerinnen und
Schülern der 9. und 10. Klasse in Bayern, Berlin, Brandenburg, Hessen,
Mecklenburg-Vorpommern, Saarland und Thüringen. In IFT-Berichte.
Volume 165. München: Institut für Therapieforschung; 2008.
11. Stander V, Orth B, Töppich J: Die Drogenaffinität Jugendlicher in der
Bundesrepublik Deutschland 2008. Köln: BZgA - Bundeszentrale für
gesundheitliche Aufklärung; 2008.
12. Schenk L, Neuhauser H, Ellert U: Kinder- und Jugendgesund-heitssurvey
(KiGGS) 2003-2006: Kinder und Jugendliche mit Migrationshintergrund
in Deutschland. Beiträge zur Gesundheitsberichterstattung des Bundes Berlin:
Robert Koch Institut; 2008.
Donath et al. BMC Public Health 2011, 11:84 Page 14 of 14
http://www.biomedcentral.com/1471-2458/11/84

13. Enoch M: Genetic and Environmental Influences on the Development of

Alcoholism - Resilience vs. Risk. Annals New York Academy of Sciences
2006, 1094:193-201.
14. Baier D, Pfeiffer C, Simonson J, Rabold S: Jugendliche in Deutschland als
Opfer und Täter von Gewalt. Erster Forschungsbericht zum
gemeinsamen Forschungsprojekt des Bundesministeriums des Innern
und des KFN. In Forschungsberichte. Volume 107. Edited by: KFN. Hannover:
Kriminologisches Forschungsinstitut Niedersachsen; 2009.
15. Wetzels P, Enzmann D, Mecklenburg E, Pfeiffer C: Jugend und Gewalt. Eine
repräsentative Dunkelfeldanalyse in München und acht anderen deutschen
Städten Baden-Baden: Nomos; 2001.
16. Die Drogenaffinität Jugendlicher in der Bundesrepublik Deutschland
2004. [http://www.bzga.de/?
uid=1607669916cee9e46173d2ab38808c9e&id=studien&sid=-1&sub=24.htm].
17. Gravetter FJ, Wallnau LB: Essentials of statistics for the behavioral sciences
Belmont: Thomson; 2008.
18. Baier D, Rabold S: Drogenkonsum im Jugendalter - Verbreitung,
Bedingungsfaktoren und Zusammenhang mit Gewaltverhalten. Zeitschrift
für Jugendkriminalrecht und Jugendhilfe 2009, 20(4):292-306.
19. Romaus A, Güther B: Cool ohne Qualm - Abheben ohne Alkohol München:
Landeszentrale für Gesundheit in Bayern e.V; 2004.
20. Bühler A: Was wirkt in der Suchtprävention? Deutsche Medizinische
Wochenschrift 2009, 134(47):2388-2391.
21. Wechsler H, Nelson T: What we have learned from the Harvard School of
Public Health College alcohol study: Focussing attention on college
student alcohol consumption and the environmental conditions that
promote it. Journal of Studies on Alcohol and Drugs 2008, 69(4):481-490.
22. Sartor C, Lynskey M, Heath A, Jacob T, True W: The role of childhood risk
factors in initiation of alcohol use and progression to alcohol
dependence. Addiction 2006, 102:216-225.
23. Petraitis J, Flay B, Miller T, Torpy E, Greiner B: Illicit substance use among
adolescents: a matrix of prospective predictors. Substance Use and Misuse
1998, 33(13):2561-2564.
24. Tucker J, Ellickson P, Klein D: Growing up in a permisse household: What
deters at-risk adolescents from heavy drinking? Journal of Studies on
Alcohol and Drugs 2008, 69(4):528.
25. Norman P, Bennet P, Lewis H: Understanding binge drinking among
young people: an application of the Theory of Planned Behaviour.
Health Education Research 1998, 13(2):163-169.
26. Donath C, Metz K, Chmitorz A, Gradl S, Piontek D, Flöter S, Kröger C,
Reschke K: Prediction of alcohol addicted patients’ smoking status
through hospital tobacco control policy: a multi-level-analysis. Drugs:
education, prevention and policy 2009, 16(11):53-70.
27. Piontek D, Buehler A, Donath C, Floeter S, Rudolph U, Metz K, Gradl S,
Kroeger C: School context variables and students’ smoking. European
Addiction Research 2008, 14:53-60.
28. Piontek D, Buehler A, Rudolph U, Metz K, Gradl S, Floeter S, Donath C:
Social contexts in adolescent smoking: does school policy matter? Health
Education Research 2008, 23(6):1029-1038.
29. Saunders JB, Aasland OG, Amundsen A, Grant M: Alcohol consumption
and related problems among primary health care patients: WHO
Collaborative Project on Early Detection of Persons with Harmful
Alcohol Consumption - I. Addiction 1993, 88:349-362.
30. De Bellis M, Narasimhan A, Thatcher D, Keshavan M, Soloff P, Clark D:
Prefrontal cortex, thalamus, and cerebellar volumes in adolescents and
young adults with adolescent-onset alcohol use disorders and comorbid
mental disorders. Alcoholism: Clinical and Experimental Research 2005,
29(9):1590-1600.
31. IAS: Binge drinking - medical and social consequences. IAS Factsheet St. Submit your next manuscript to BioMed Central
Ives: Institute of Alcohol Studies; 2007. and take full advantage of:
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